HomeMy WebLinkAboutPermit Mechanical 1986-8-11
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!.;-. DO I
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i ,t,d
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I~, ~ I TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
IItISPECTIOII LlIIE
726-3769 .
Job Address
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Legal De~cript;on
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Owner . ~.uJ J;U..f ,/7
Address . W/:;-~i'gl.~'1
:~L/O '-i I-(+H I-)I~, ,t,
Construct;nn lender
Address
DESIGil lEAn
(name)
Primary
Structura 1
Electrical
Hechanical
CONTRACTORS
(name)
Genera 1
Plumbina
f),/j}l1fA~
Electrical
P,lechanical
PLUIIBIIIG
riD.
FfE CH^Rr.F ~ln
Each single fixture
Relocated building
(new fix. additional)
S. F. Res i dence .
11 bath}
IOuPlex (1 bath) each
Add it; ona I ba th
~!ater service
Sewer
Storm Sewer
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TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
CITY UF SPRINGFIELU
CmlBlllATlON APPLICATION/PERMIT
EIIERr,y SOURCES:
Heat
\~ater Heater
JNFORlIATION lI..c Ii
726-3753
Sa. Ftq. I.lain
!:q. !='tg. Access.
Sq. Ftq. Other
Ilew Add Alter f!ep.
_Fence_Demo _Change/Use
_Other
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Phone / :::-
Ranqe
ValuE of 1.lode:
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Bu11(;ino Permit Info: Describe \~ork(i~e., Build Single
Far.1i 1 v nes i dence I,ll th f\.t tached t;a raae)
JYrJ?} - r..1/J1 fin ./1
l/7ItrllJ,,'f'
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Phone
(address)
(I ics. no.)
(exoires I
(ohone no.
'address)
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(lies. nrf) '(pxoirpc;\
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ELECTRICAL
MECHANICAL
Residence of
>>L J:JJARliL \ 110
'tLL'J:liAB.liE..
sq. FT.
furnace/burner to
BTU's
New circuits alts.
or extensions
Floor furnace.
and vent
SERVICES
Recessed wall
~~~~p hp~tpr ~nn 4pnr
Temporary Construction
Change in existing
rpc;jdpn~p
Imultifami ly, COrm!. or
Tnnllc:tr;<'ll
I Apol iance vent
!'poa ra tp
Sta t i onary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hoon <'lnd du('t
from
Of
amps.l
COI1l.1.11 NO. FEEDERS
I Install/alter/relocate
n;c;tr;h. fppdprc:
jOf
Wood stove/heater
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I TOTAL
ISSUANCF OF PFR!I!T
CHARGES
amps.
Electrical Contractor, the electrical rortion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1WED the completed apr1ication for oermit, and do hereb.v certify that all infonnation hereon is true
and correct. and I further certifv that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Oref)on ~ertaining to the work described herein, and that tlD OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as reouired by ORS 701.055, that if exempt the basis for exem t.on is noted hereon, and that
only subcontractors and employees who are in com~liance with OP.S 701.055 will be nth. P J t.
IIA:-IE(please
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pr;~.LR~N()A ThOt'Yl"Sc)f\J SIr.lI(rU~
FO~ OrFIC!: USE Dill Y-
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
BUILOIIIG PERfIIT
Charges ane
Surcharges
DATE
<6'-I\~,
'..J
Units
Occy load
Occy Group
Sq. Ftg. lla;n
Sq. Ft~. A~cess
Sq. Ftg. Other
x
x
Value
Value
Value
,
TOTAL VALUATIOrl
Plan Ck. Comm/lnd
65%/Rlrlo Ppr Fpp
------------PTan Ck. R.es
30%/Bldo Per Fee
I Fence
PLU'1BING PERMIT
Charges and
SurCharges
. (otl
-------$..
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ELECTRIUL PER1:IT
Charges and
Surcha rges
rlECHANICAL PERMIT
Charges and
Surcharges
Systems Development
CharQe (1.5~)
Demo
Sidewalk
1 A/C Paving
I Curb Cut
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Total Comb. rermit
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I TOTAL
(51(0'0
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax lot -lOa. lane County Map Reference
11 03 43
2, examole- Lot I. Block 3. 2nd Addition to
)pnngtield Estates .
C. Name. etc. of owner and construction lender
n Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square tootage or valuation, etc. ------
I. examole- 12S0 sq. foot house, SOO sq. foot garage
2. example- if new project. check new - if addition,
check add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached garoge
2. examole - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (Change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonmatlon or jOb site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces OCcur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit fonm the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the label must be delivered to the
electrical contractor for Signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label. -
III. Applicant to sign and date
Whenever possible, the initial"application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the penmit is issued.
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V. FOR OFFICE USE ONLY
Permi t Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from registration with the Builder.' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date